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NON-HAZARDOUS 1.Generator's US EPA ID No. Manifest Doc.No. 2. Page 1 <br /> WASTE MANIFEST .(AO 0C1l ;CGL r�(I {-'Cjc,�Ci I 1 of i C17 <br /> 3. Generator's Name and Mailing Address <br /> Z6 <br /> 4. Genera ors Phone 1C� ., p` <br /> 5. Transporter 1 Company Name Ip 6. US EPA'ID Number A. Transporter's Phone <br /> l� CL41,6 COti.P n a-.ix,)iHl <br /> 7. Transporter 2 Company Name V 8. US EPA ID Number B. Transporter's Phone <br /> 9 Qesicgnaled Fa lity Name and Site Ad`dregts f� 10. US EPA ID Number C. Facility's Phone <br /> e rV�i'f>t .tiv i G d��1t(.� tiY�1 ` Y AVnQv+T LL C <br /> 1� R 011. Waste Shipping Name and Description 12. Containers 137 14. <br /> Total Unit <br /> No. I Type Quantity WINol <br /> a. n . -7q �rr �P 4%J�2Ilt $� Pyr `�1' <br /> 0( . <br /> (00 f 5 ,�1 Lur'}S ` 1S 'r 3 <br /> E b. A im + �y� S�.a�1 t �G�al (a��}c + I�,Q �0 U'Q,)PcC) <br /> R <br /> A c. <br /> T <br /> 0 <br /> R <br /> d. <br /> D. Additional Descriptions for Materials Listed Above E. Handling Codes for Wastes Listed Above <br /> 15, Special Handling Instructions and Additional Information <br /> 1:n GQ ` <br /> 16.GENERATOR'S CERTIFICATION;"I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br /> and are classified, packaged,marked and labelled/placarded, and are in all respects in proper condition for transport according to applicable international and <br /> national .vernmental regulations."I also certify that all times listed above are true and correct. <br /> Printed/Typed Name r Month Day Year <br /> R17.Transporter 1 Acknowledgement of Receipt of Materials <br /> A Printed/Ty ed Name Signature Month Day Year <br /> R 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> E Printedfryped Name Signature Month ,pay year <br /> R <br /> 19.Discrepancy Indication Space <br /> A' <br /> G <br /> L 20.Facility Owner or Operator:Certification of receipt of waste materials covered by this manifest except as noted in item 19. <br /> 1 <br /> T <br /> Y <br /> Printed/Typed Name Signature Month Day Year <br /> ORIGINAL- RETURN TO Gf=NE Ti OR <br /> Rca, 9 <br />